title: Unconsciousness and sedation as precipitating factors of diabetic ketoacidosis.
abstract: The aim of this study was to identify medico-legal situations characterized by increased vitreous glucose concentrations, potentially lethal blood 3-hydroxybutyrate levels and conditions that could either incapacitate or lead to death on their own. The above was investigated in order to verify whether prolonged states of unconsciousness may play a role in precipitating diabetic ketoacidosis. Six groups of medico-legal situations (corresponding to 206 autopsy cases) were identified. Among these, three cases were characterized by pathologically increased vitreous glucose and blood 3-hydroxybutyrate levels. In one case diabetic ketoacidosis coexisted with underlying features that might have potentially incapacitated or lead to death on their own, whereas in two cases it corresponded with potentially lethal or lethal drug concentrations. The results of this study highlight the usefulness of systematically performing biochemistry in order to identify diabetic ketoacidosis-related deaths, even when autopsy and toxicology results provide apparently conclusive findings.
authors.affiliation: University Centre of Legal Medicine, Lausanne-Geneva, Rue du Bugnon 21, 1011 Lausanne, Rue Michel-Servet 1, 1211 Geneva, Switzerland. Electronic address: cristian.palmiere@chuv.ch.
authors.forename: Cristian
authors.initials: C
authors.lastname: Palmiere
authors.forename: Maria del Mar
authors.initials: Mdel M
authors.lastname: Lesta
authors.forename: Sara
authors.initials: S
authors.lastname: Sabatasso
authors.forename: Johannes Alexander
authors.initials: JA
authors.lastname: Lobrinus
authors.forename: Marc
authors.initials: M
authors.lastname: Augsburger
authors.forename: Dominique
authors.initials: D
authors.lastname: Werner
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood; D000328:Adult; D001284:Atrophy; D016292:Procedural Sedation; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D007515:Islets of Langerhans / Q000473:pathology; D007657:Ketone Bodies / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications; D014474:Unconsciousness; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D007657:Ketone Bodies; D005947:Glucose; D020155:3-Hydroxybutyric Acid
keywords: Diabetes; Ketoacidosis; Ketone bodies; Postmortem biochemistry; Unconsciousness; Vitreous humor